Anne Dixon, a pulmonologist in Vermont, vividly recalls the early days of the Covid-19 pandemic, recalling one particularly heartbreaking patient death.
“We had someone who was very young, who suffered from obesity and who died of Covid. It was quite devastating,” said Dixonprofessor of medicine at the University of Vermont Medical Center.
It was a wake-up call that the pandemic was going to be worse for people with obesity, and studies have since shown that obesity is associated with a higher risk of severe Covid. Severe Covid means cases that require hospitalization, admission to intensive care and use of a ventilator. Obese people also have a higher risk of Covid-related death.
“Even here in Vermont, which is a relatively lean state compared to many others, we’ve seen obese people come in and die in our intensive care unit,” said Dixon, who studies the effect of obesity on lung health. “We analyzed our data and found that people admitted to our intensive care unit were much more likely to (have obesity) than people admitted to the usual medical floor only.”
The Covid pandemic has killed more than 1.1 million people in the United States since 2020, and while the declaration of a public health emergency has finishedCovid continues to be dangerous for many people, including those living with obesity.
Watch: Ask the Expert: Covid-19 and Obesity >>
What is obesity?
Obesity is a disease in which an excessive amount of body fat leads to body mass index (BMI) of 30 or more. In contrast, people in a “healthy weight range” typically have a BMI of 18.5 to 24.9.
In 1990, approximately 1 in 10 American adults suffered from obesity. Today, 4 out of 10 adults live with obesity. A study estimates that by 2030, half of all American adults will be obese.
“It’s your mother, it’s your sister, your brother, your daughter – the prevalence is so high in our country,” said Loretta Lee, Ph.D., RNco-chair of the Nurse’s Obesity Network and associate professor of family, community and health systems at the University of Alabama at Birmingham School of Nursing.
How obesity puts people at risk of severe Covid disease
Obesity can have a negative effect on almost every system in your body, from your cardiovascular (heart) and endocrine (hormones) systems to your mental health.
“If a person is diagnosed with obesity, almost any chronic disease they have is likely to get worse…because obesity is linked to impaired immune function,” Lee said. “That’s why obese people have worse outcomes with Covid compared to people who don’t live with obesity.”
People with obesity are more likely to have other diseases, such as heart disease, lung disease, and diabetes, which are each risk factors for serious complications of Covid. In addition, obese people are more likely to have lower lung capacity, putting them at risk for respiratory illnesses and more serious illnesses. For example, obese people are hospitalized for asthma-related complications at 5 times the rate of people without obesity.
“If your lungs are already a bit compromised and your immune system isn’t working as well, the combined effects can be absolutely disastrous,” Dixon said.
Covid attacks the lining of the lungs. While most people have mild symptoms of Covid, obese people often have a more severe response to the virus, leading to serious consequences such as organ damage, mental and physical impairments and long Covid caused by inflammation over time, Lee said.
A recent study from Stanford University discovered that SARS-CoV-2, the virus that causes Covid, attacks fatty tissue. The virus then makes copies of itself in the fat cells and causes additional infections in other cells. Adipose tissue contains macrophages, immune cells that alert the body to threats and attack them. When these immune cells are infected with the virus, they become inflamed and cause other nearby cells to become inflamed.
One of the study’s authors, Catherine Blish, MD, Ph.D., a professor of infectious diseases at Stanford University, explained that macrophages release proteins that tell other cells that there is a threat. These cells then attract other inflammatory cells.
Why is this a problem for obese people? One theory is that obese people have more fatty tissue and are therefore more susceptible to this spread of Covid-induced inflammation – although this has not been proven. But, Blish said we know that fatty tissue in obese people already has additional inflammation to begin with, so the inflammatory response to the virus could be more severe than in people who aren’t obese.
“Fat tissue also covers many of our vital organs, like our heart all around our gut. Having inflamed fat right next to your core isn’t exactly an ideal situation,” Blish said.
How to protect yourself from Covid if you live with obesity
The Covid remains a real threat for obese people. Wearing a mask when you are in public can reduce your chances of catching the virus.
But, by far, the best way to protect yourself is the vaccine. To get vaccinated can significantly reduce your chances of contracting severe Covid, being hospitalized or dying from Covid.
“I would definitely recommend obese people get vaccinated against Covid. It’s our best defense,” Dixon said.
If you are immunocompromised, you may want to consider additional doses of the vaccine for added protection. You should also make sure to act quickly if you have symptoms of Covid and/or test positive. Call your health care provider right away and ask if you are a good candidate for treatment.
Also, be sure to keep up to date with The latest CDC guidelines on the Covid vaccine and talk to your health care provider about your personal situation.
“In addition to getting vaccinated, try to build a healthy lifestyle,” Lee advised. This includes adding more fresh vegetables to your diet, reducing processed foods, and incorporating exercise into your daily routine. While way of life might not be the cause of obesity or a quick fix, healthier choices – with the vaccine – can help you avoid the worst outcomes of Covid.
If you are living with obesity and suspect you have Covid, contact your health care provider immediately.
This resource was created with support from Pfizer.
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